Salvatore Ernest Genco, DMD
Individual provider Active NPI Dentist · Pine Bush, NY
NPI 1609085091 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1609085091
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 047434-1 (NY)
- Practice address
- 102 Maple Ave
Pine Bush, NY 12566-7119 - Phone
- (845) 744-5570
- Fax
- (845) 744-2782
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047434-1 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maple Ave. Dental | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 047434-1 | NY | Yes |
Addresses
Primary practice location
102 Maple Ave
Pine Bush, NY 12566-7119
Mailing address
PO Box 290
Pine Bush, NY 12566-0290
Phone (845) 744-5570
Other providers in Pine Bush, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.